- Molina Healthcare (Green Bay, WI)
- …role will be responsible for work around Program Valuation on Molina's Risk Adjustment Actuarial team. Responsibilities include research, analysis and modeling ... complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate healthcare...risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA… more
- Humana (Madison, WI)
- …**Preferred skills** + FSA or plus relevant advanced degree + Experience with Medicare Part D + Familiarity with Risk Score Data + Python **Additional ... MRA Finance team and plays a critical part in forecasting risk scores and revenue for the Medicare Advantage Part D business. The successful candidate will lead… more
- Molina Healthcare (Janesville, WI)
- …medical plan of care and capture diagnoses for Medicare risk adjustment . The NP/PA will utilize advanced assessment skills to diagnose and manage chronic ... member health outcomes. The NP/PA is responsible for completing advanced practice consultations for enrolled members in the various...+ Capture and document annual diagnoses accurately consistent with Medicare risk adjustment . + Conduct… more
- Humana (Madison, WI)
- …a pivotal role within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. In this position, the Senior Research Scientist ... will apply advanced statistical methods to rigorously evaluate the impact of risk adjustment programs and pilot projects. The findings generated will be… more
- Humana (Madison, WI)
- …plays a pivotal role within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. The Senior Data Scientist in this role will ... technology to transform high volumes of complex data into advanced analytic solutions. The Senior Data Scientist work assignments...empower risk adjustment decision makers through predictive analytics.… more
- Humana (Madison, WI)
- …a pivotal role within Humana, delivering insights that drive the effectiveness of risk adjustment initiatives. In this position, the Research Scientist 2 will ... partner with a senior research scientist to apply advanced statistical methods to rigorously evaluate the impact of... statistical methods to rigorously evaluate the impact of risk adjustment programs and pilot projects. The… more
- Datavant (Madison, WI)
- …outpatient or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment , CDI, Medicaid, Commercial RA, and HEDIS ... up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide...clients understand the shifts and trends happening in the risk adjustment coding space. **What you will… more
- Humana (Madison, WI)
- …+ A strong understanding of clinical metrics and data (eg Quality measures, Risk Adjustment ratings, chronic condition management, PCP visit rates and ... interrelate across segments and/or enterprise-wide. **Regional VP of Health Services, Humana Medicare Advantage** As the Regional VP of Health Services, you will… more